03+供氧与耗氧，休克.pptVIP

常用供氧与耗氧的监测 DO2=1.38×Hb×SaO2×CO (ml/min) VO2=CO×(CaO2-CvO2)(ml/min) 测定Hct及Hb的方法 全血细胞分析仪-- Hct、Hb 血气分析仪– Hct、Hb 血红蛋白分光光度仪-- Hb 离心机—Hct 术中常用的CO监测方法 右心飘浮导管 Picco (外周动脉) FloTrac 传感器 TEE PiCCO Using PiCCO typically requires insertion of a thermodilution catheter in the femoral or axillary artery instead of a standard arterial line. Any available central venous catheter can be used to inject the solution for the thermodilution analysis. 术中TEE测量CO M型法 短轴缩短率： FAC=(EDA-ESA)/EDA ; 自动边缘识别系统（ABD） 二维Simpson法 SV=LVEDV-LVSDV 多谱勒法 SV=时间速度积分X横截面积 三维法 Gastric tonometry determines intraluminal PCO2 which is assumed to be in equilibrium with PCO2 in the gastric mucosa. Intramucosal pH (pHim) can be calculated by the Henderson-Hasselbach equation using the PCO2 value determined by gastric tonometry and the bicarbonate concentration in arterial blood. 决定DO2与VO2的因素 术中影响氧供的因素 低氧血症和缺氧hypoxaemia and anoxia PaO260mmHg, SpO2 低张性缺氧 血液性缺氧 循环性缺氧 组织性缺氧 请思考 术中监测氧供和氧耗的指标？ 术中引起氧供下降的因素？ 术中增加氧供、降低氧耗的措施？ 低血容量性休克的体征与失血量 * For a patient with an Hb of 15 g/0.1 L, PaO2 of 100 mm Hg, and PvO2 of 40 mm Hg, arterial O2 content (CaO2) = (1.39) (15)(1) + (0.003)(100) = 20.9 + 0.3 = 21.2 mL of O2 /0.1 L; mixed venous O2 content ( ) = (1.39)(15)(0.75) – (0.003)(40) = 15.6 + 0.1 = 15.2 mL of O2 /0.1 L. Thus, the normal arteriovenous O2 content difference is approximately 5.5 mL/0.1 L. * * The oxygen-hemoglobin dissociation curve. Four different ordinates are shown as a function of oxygen partial pressure (the abscissa). In order from right to left, they are: saturation (%), O2 content (mL of O2/0.1 L) of blood; O2 supply to the peripheral tissues (mL/min); and O2 available to the peripheral tissues (mL/min), which is O2 supply minus approximately 200 mL/min that cannot be extracted below a partial pressure of 20 mm Hg. Three points are shown on the curve: a, normal arterial; v, normal mixed venous; and P50, the partial pressure (27 mm Hg) at which hemoglobin is 50 percent saturated. The o